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Biomedical subjects

R B George

Publications and source records attributed to R B George.

At least 55 records · Page 3Linked to original sources
PubMed1988

Fungal diseases of the pleura: clinical manifestations, diagnosis, and treatment.

Fungal respiratory infections were once considered rare and limited to certain endemic areas in the southeastern United States or the western desert areas. With the development and increasing use of agents that alter host immunity, as well as the spread of human immune deficiency virus infections in this country, the incidence and clinical features of fungal infections are changing. Opportunistic fungi, ubiquitous in our environment, have become common infectious agents in hospitalized patients. The pathogenic fungi are no longer considered to be limited to certain geographic areas because of the increased mobility of the population and reports of infections outside the usual endemic areas. Both opportunistic and pathogenic fungi may infect the pleural space, and symptoms of pleural disease may be the presenting complaint in patients with respiratory mycoses. This review summarizes the common clinical findings in fungal infections of the pleura, including those findings that suggest a fungal etiology. Diagnostic studies used to define the etiologic agent and recommended therapeutic approaches are also discussed.

Antifungal Agents↗
PubMed1988

Respiratory physical therapy in the treatment of chronic bronchitis.

Currently recommended respiratory physical therapy procedures include measures designed to improve the clearance of secretions from the lungs, improve distribution of inspired air, and improve the general physical condition. In patients with chronic bronchitis there is frequently an abundance of thick, tenacious bronchial secretions associated with defective mucociliary function due to diffuse disease of the airways. Those who are unable to clear their secretions adequately are candidates for one or more of the techniques discussed here. In designing a treatment plan for the chronic bronchitic, it is important to use only those techniques with demonstrated benefit and minimal hazard in that particular patient.

Breathing Exercises↗
PubMed1987

Unilateral absence of ventilation and perfusion associated with a bronchial mucous plug.

We have described a patient in whom loss of ventilation and perfusion of an entire lung resulted from mucous impaction of a major bronchus. Mucous plugging was associated with the combination of asthma and decreased cough effectiveness due to paraplegia. Removal of the obstruction by bronchial aspiration followed by vigorous pulmonary physical therapy resulted in return of both ventilation and perfusion to the lung and relief of dyspnea and hypoxemia.

Adult↗
PubMed1987

Evaluation of enzyme immunoassay as a rapid screening test for histoplasmosis and blastomycosis.

This study evaluates the usefulness of enzyme immunoassay (EIA) as a screening test for serum antibodies to Histoplasma capsulatum and Blastomycoses dermatitidis and compares the results using this assay with those using complement fixation (CF), immunodiffusion (ID), and radioimmunoassay (RIA), in 12 patients with active histoplasmosis, 12 with active blastomycosis, 28 with other acute or chronic lung diseases and 25 healthy blood donors from an endemic area; EIA was as sensitive as RIA and more sensitive than CF and ID in the 24 patients with active fungal infections. The specificity of EIA was equal to that of the other serologic tests. We conclude that EIA is a useful screening test for serum antibodies to H. capsulatum and B. dermatitidis that avoids some of the problems associated with other sensitive assays such as RIA. A negative EIA result is evidence against invasive histoplasmosis or blastomycosis and suggests an alternative diagnosis.

Antigens, Fungal↗
PubMed1987

Influence of spirometry and chest roentgenography on the management of pulmonary outpatients.

Spirometry and chest roentgenography are frequently employed to evaluate patients with respiratory problems. To determine their impact on the management of outpatients with lung disease, both tests were performed on 100 consecutive patients (40 men and 60 women; mean age, 52 +/- 15 years) who returned for reevaluation 16 +/- 9 weeks after their previous clinic visit. Patients with obstructive (n = 45), restrictive (n = 35), and mixed (n = 20) lung diseases were initially assessed by history and physical examination and classified clinically as improved, stable, or worse. A clinical management plan (CMP) was formulated based on this initial evaluation. Changes in the proposed CMP due to spirographic or roentgenographic results were then noted. None of the 19 patients who were clinically improved and only two (3%) of the 64 clinically stable patients had a change in CMP. In contrast, five (29%) of the 17 patients whose conditions deteriorated clinically had their proposed CMP modified after review of the spirograms and roentgenograms. Therapy was intensified in three of the seven patients whose CMPs were modified, while in the other four, treatment was withheld because results of both tests were unchanged. These results indicate that routine spirograms and chest films have little influence on the CMP of clinically stable patients. However, unexpected roentgenographic and spirometric findings frequently alter the management of the individual whose condition has clinically deteriorated.

Adult↗
PubMed1986

Optimal dose of fenoterol by metered-dose inhaler in asthmatic adults.

Three doses of fenoterol were administered by metered-dose inhaler to 20 adult subjects with asthma in order to determine the optimal dose for routine administration. Inhaled doses of 100 micrograms, 200 micrograms, and 400 micrograms of fenoterol with isoproterenol and placebo controls were administered in a randomized double-blind crossover regimen. We found that 200 micrograms of fenoterol by metered-dose inhaler produced a longer duration of action, greater peak response, and greater overall time-weighted responses in the forced expiratory volume in one second, in the mean forced expiratory flow during the middle half of the forced vital capacity, and in airway resistance than did the other drug regimens. The 400 micrograms dose of fenoterol produced no increase in response over that seen after the 200 micrograms dose. Side effects were minimal and no greater than with isoproterenol.

Administration, Intranasal↗
PubMed1986

Antibody coating and quantitative cultures of bacteria in sputum and bronchial brush specimens from patients with stable chronic bronchitis.

Antibody coating of bacterial isolates has been proposed as a method of identifying bacteria responsible for chronic lower respiratory infections. This study was designed to determine the specificity of antibody coating by examining bronchial secretions obtained from a group of patients with chronic bronchitis who had no clinical evidence of acute infection. Routine and quantitative bacterial cultures were performed at the same time. The bronchial brush specimens contained potentially pathogenic bacteria in all 18 patients examined, and 17 of these 18 specimens had antibody coating of bacteria. Quantitative cultures yielded greater than 10(4) colony forming units in only one patient and he subsequently developed a lower respiratory tract infection. We conclude that in patients with chronic bronchitis, the determination of antibody coating of bacterial isolates does not significantly increase the specificity of routine culture. Quantitative cultures of specimens obtained via the protected brush catheter are useful in identifying potential pathogens.

Bronchi↗
PubMed1986

Effect of aminophylline on exercise performance in patients with irreversible airway obstruction.

Thirteen clinically stable male patients aged 63 +/- 3 years with irreversible airway disease were given aminophylline and placebo in a randomized crossover fashion on two consecutive days while receiving beta-agonists. During incremental exercise the maximal heart rate (139.0 +/- 22.1 vs 128.0 +/- 16.4 beats per minute) and minute ventilation (41.9 +/- 6.9 vs 38.1 +/- 8.2 L/min) were significantly higher and the arterial carbon dioxide pressure (34.6 +/- 5.0 vs 38.6 +/- 7.7 mm Hg) was significantly lower during aminophylline administration than during placebo administration. However, spirometric findings, maximal inspiratory pressures, maximal oxygen consumption, work rate, and arterial oxygen pressure were similar on both regimens. We concluded that the major effect of aminophylline is to increase ventilatory drive in patients with irreversible airway obstruction. Unless an objective change in spirometric data or exercise capacity can be documented, we believe that aminophylline therapy is not warranted in these patients.

Aged↗
PubMed1986

Antigen detection in the diagnosis of fungal respiratory infections.

The diagnosis of fungal infections of the respiratory tract is often difficult and may require invasive diagnostic procedures. The detection of soluble fungal antigens in bodily fluids such as serum, pleural fluid, and bronchoalveolar lavage fluid may substantially improve the ability to diagnose fungal respiratory diseases. For instance, uncommon presentations of diseases with the pathogenic fungi, such as chronic cavitary histoplasmosis, coccidioidal empyema, and cryptococcal pneumonia are often difficult to diagnose with present techniques, and the detection of fungal antigens may prove to be more sensitive. There is an especially urgent need for sensitive, reliable, commercially available tests for the diagnosis of opportunistic fungal pneumonias that occur in immunocompromised hosts. Preliminary data holds promise for the noninvasive diagnosis of deep-seated candidiasis (including pneumonia) and pulmonary aspergillosis by the detection of fungal antigens in serum and bronchoalveolar lavage fluid. We review current techniques used for the detection of fungal antigens, including their sensitivity and specificity, and their use in diagnosing human infections.

Antigens, Fungal↗
PubMed1985

Value of routine daily chest x-rays in the medical intensive care unit.

To ascertain the value of the daily routine chest x-ray in the medical ICU, we determined prospectively the number of unsuspected abnormalities observed on 507 consecutive chest films and the consequent management changes in 94 ICU patients. Primary diagnoses were classified as pulmonary, hemodynamically unstable cardiac, uncomplicated cardiac, or miscellaneous. Admission films and those taken after procedures or a change in clinical status were excluded. Ventilator status and the tubes and catheters visible on the films were also noted. After clinical evaluation, management plans were made by ICU physicians and then the chest x-ray was examined and unsuspected abnormalities and resulting management changes were noted. Of the 507 chest films, 76 (15%) revealed an unsuspected abnormality, 71 (93%) of which led to a management change. There were significantly (p less than .02) more unsuspected abnormalities and management changes in the pulmonary and unstable cardiac patients, independent of ventilator status. Patients with two or more catheters and/or tubes visible on the chest film also had significantly more management changes (51/312 vs. 11/150, p less than .05). We conclude that while routine chest films affect the management of pulmonary and unstable cardiac patients in the ICU, routine films rarely influence management of uncomplicated cardiac patients and those without heart or lung disease, and are not warranted in this group.

Critical Care↗
PubMed1985

Inability of awake patients to correctly locate a cough stimulus.

To determine whether patients can accurately identify the lung in which a cough reflex originates, a unilateral cough stimulus was administered to 67 patients during fiberoptic bronchoscopy. Although the stimulus produced a vigorous cough reflex in all subjects, 51 of 67 individuals were unable to identify the side stimulated. These results suggest that impulses from endobronchial irritant receptors are not perceived cortically as originating within a particular hemithorax.

Bronchoscopy↗
PubMed1985

Effect of steroid therapy on exercise performance in patients with irreversible chronic obstructive pulmonary disease.

Many patients with irreversible chronic obstructive pulmonary disease (COPD) claim symptomatic improvement with steroid therapy, despite a lack of objective improvement in their spirometric data. To determine if steroids actually increase the exercise capacity of these individuals, 13 clinically stable patients (mean age, 63 +/- 4 years; 12 male patients) were given methylprednisolone (32 mg once daily) or placebo in a randomized double-blind crossover fashion. Spirometric data and minute ventilation, oxygen consumption (VO2), carbon dioxide production, and heart rate during incremental exercise were measured at each visit. Methylprednisolone did not produce a significant change in any of the measured parameters. Three patients had an increase in maximal VO2 of greater than 2 ml/kg/min during therapy with methylprednisolone, while two experienced a decline in maximal VO2 of similar magnitude. The change in exercise capacity was unrelated to the change in the forced expiratory volume in one second in individual patients (r = 0.08). We conclude that in the absence of any improvement in the usual tests of airway mechanics, steroid therapy does not improve exercise performance in patients with COPD.

Adrenal Cortex Hormones↗
PubMed1985

Comparison of the effects of labetalol and hydrochlorothiazide on the ventilatory function of hypertensive patients with asthma and propranolol sensitivity.

Previous studies have shown that labetalol, a new alpha- and beta-adrenergic antagonist, is relatively safe for the treatment of hypertension in patients with chronic obstructive pulmonary disease (COPD). This multicenter study was designed to evaluate its effects in hypertensive patients with asthma and propranolol sensitivity. Hypertension was successfully controlled in 18 of 21 patients who received labetalol in increasing doses, up to 1,200 mg/day. The decrease in mean FEV1 (1.5 percent) two hours after the highest dose of labetalol was not statistically significant, although there was a gradual decline in mean baseline FEV1 during the four-week treatment period. Antihypertensive agents other than adrenergic antagonists should be considered for the management of hypertension in patients with asthma, especially those with marked reversibility of airflow. If treatment with beta-adrenergic antagonists is indicated, labetalol is recommended over other currently available agents.

Adolescent↗
PubMed1985

The use of labetalol for the treatment of hypertension in patients with reversible airway obstruction.

Beta-adrenergic blocking agents are commonly used for the management of hypertension, cardiac arrhythmias, and angina pectoris; several of these agents are now available for clinical use (1-5). A significant side effect of these agents in patients experiencing reversible airway obstruction is that they block the effects of beta-adrenergic agonists and can precipitate or worsen bronchospasm (6-8). Labetalol, a new adrenergic antagonist with both alpha- and beta-adrenergic blocking effects, has been shown to have certain advantages for the management of hypertension and is widely used for this purpose in many countries (9). To evaluate its effects on airway resistance in patients with obstructive lung disease, the authors conducted two separate clinical studies. This article summarizes the results of these trials.

Airway Resistance↗